While interviewing a client, the nurse records the assessment in the electronic health record. Which statement is most accurate regarding electronic documentation during an interview?

The client's comfort level is increased when the nurse breaks eye contact to type notes into the record.

Completing the electronic record during an interview is a legal obligation of the examining nurse.

The nurse has limited ability to observe nonverbal communication while entering the assessment electronically.

The interview process is enhanced with electronic documentation and allows the client to speak at a normal pace.

Answer and Explanation

The Correct Answer is C

Choice A reason: This is an incorrect statement as it implies that breaking eye contact is beneficial for the client. In fact, breaking eye contact may reduce the client's trust and rapport with the nurse. The nurse should maintain eye contact as much as possible and use verbal and nonverbal cues to show active listening.

Choice B reason: This is an incorrect statement as it implies that electronic documentation is mandatory for all interviews. In fact, electronic documentation is not a legal obligation, but a preferred method of recording the assessment data. The nurse should follow the facility's policy and procedure for electronic documentation and ensure the accuracy, completeness, and confidentiality of the record.

Choice C reason: This is the correct statement as it acknowledges the challenge of electronic documentation during an interview. The nurse may miss some important nonverbal cues from the client, such as facial expressions, gestures, or posture, while typing on the computer. The nurse should balance the time spent on the computer and the time spent on the client and use open-ended questions and reflective statements to elicit more information.

Choice D reason: This is an incorrect statement as it implies that electronic documentation is beneficial for the interview process. In fact, electronic documentation may interfere with the flow and quality of the interview. The client may feel rushed or ignored by the nurse's attention to the computer. The nurse should pace the interview according to the client's needs and preferences and use electronic documentation as a tool, not a barrier.

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Correct Answer is B

Explanation

Choice A reason: Applying lubricant to the cannula tubing is not the best intervention as it may cause irritation or infection of the nasal mucosa. The nurse should use water-soluble gel or saline spray to moisten the nasal passages if needed.

Choice B reason: Placing padding around the cannula tubing is the best intervention as it prevents friction and pressure on the skin. The nurse should use soft materials such as gauze or foam to cushion the tubing and check the skin integrity frequently.

Choice C reason: Decreasing the flow rate to 1 L/minute is not an appropriate intervention as it may compromise the client's oxygenation. The nurse should maintain the prescribed flow rate and monitor the client's vital signs and oxygen saturation.

Choice D reason: Discontinuing the use of the nasal cannula is not an option as it may endanger the client's life. The nurse should continue the oxygen therapy as ordered and provide comfort measures and education to the client.

A. Inject in the abdominal area at least 2 inches from the umbilicus. B. Expel the air in the prefilled syringe prior to injection. C. Rotate injections between the abdomen and gluteal areas. D. Massage the injection site to increase absorption.

Correct Answer is A

Explanation

Choice A reason: This is the correct instruction as it ensures that the injection is given in a well-perfused area with minimal risk of injury to major blood vessels or organs. The umbilicus should be avoided as it may harbor bacteria or cause discomfort.

Choice B reason: This is an incorrect instruction as it may result in a loss of medication or inaccurate dosing. The air bubble in the prefilled syringe should be left intact as it helps to seal the medication in the subcutaneous tissue and prevent leakage.

Choice C reason: This is an incorrect instruction as it may cause irritation or inflammation of the injection sites. The gluteal area should be avoided as it has a higher risk of hitting a nerve or blood vessel. The abdomen is the preferred site for low-molecular-weight heparin injections.

Choice D reason: This is an incorrect instruction as it may increase the risk of bleeding or bruising. The injection site should not be massaged or rubbed as it may dislodge the clot or damage the tissue.

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While interviewing a client, the nurse records the assessment in the electronic health record. Which statement is most accurate regarding electronic documentation during an interview?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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